, 13, 3, . 114-121 2008

. ( : , , , - ).

( ) ( ).

: , , ( ) 1,2,3.

. Willis. , .

, . , . , ,

B, 13, 3, 2008 , , . , . . . 1,2,3. , . , . , . , . . . , . . . . -

115

. . . 3 4 , 1,2. , , 1 . 3 . , . , , , . , , . , , 31 , . , , , , , .

116

, , . . ( ). . () . , , . 90 ml 150 ml 10 ml 60 ml . 20 ml 500 ml 24, . 24. , , , . (). , , , 5 ... , . ,

( ) , : , . . . , . . , . , . , , . , ( ). . , , , , . : . , . . ,

B, 13, 3, 2008 . , . , , . , , , , , 2,4,5,6. 90% . , , , . : , . . : 1) , 2) 3) . . . -

117

, . . , , , . . . , . , , , , . , , 2,4,6. . Monro 3 , Sylvius, 4 . , Lushka Magendie . -

118

. , , . , . 2,4,6. . ( ) 1,2,4,6. Paul Ehrlich, 1882, , , . ( )2. ,

. . ( 1). , , , 3. , . , .

3 Sylvius Lushka 4

1. . ( Netter FH The CiBA collection3).

B, 13, 3, 2008 : 1) , 2) , , 3) ( 2). , horseradish (Brightman Reese, 1969), , . . , . . , , , () , -

119

. , , , , . . , . . . , , , , . . , , - 2,4,6. - , . , , , 1.

2. . . ( Netter FH The CiBA collection3).

120

. , , , . . . . , . . , 6. : , .: 210 9628 343

: 1) , 2) , 3) , 4) 5) , . - ( 3). - . , , , ( ), 1,2,4,6.

Summary N. CHARALAMBAKI

Anatomic relationships of brain meninges and spinal cord Bacteriology Dept. Thriassion General Hospital Applied Clinical Microbiology

3. - . ( Netter FH The CiBA collection3).

This is a review article on CNS anatomy and physiology attempting to explain the role of the

B, 13, 3, 2008 intracranial circulation in central nervous systeminfections. (Key words: meninges, CSF, blood-brain and blood-cerebrospinal fluid barriers).

121

1. ahle W. . . , 3 : , 1985. 2. Snell RS. Clinical Neuroanatomy for Medical Students (2nd ed). Boston: Little, Brown and Company 1986.

3. Netter FH. The CIBA collection of medical illustrations. Nervous system. Part 1. Anatomy and Physiology. Vol: 1, USA: CIBA 1986, p. 31, 5455. 4. Carpenter MB. Core text of Neuroanatomy (4th) International Edition: Williams & Wilkins 1991, p. 121. 5. . . . (2 .) : 2000, . 48-53. 6. Guyton AC. Nervous System, CSF and BloodBrain and Blood-Cerebrospinal fluid Barriers. Textbook of Medical physiology. (8th ed) International edition: W.B. SAUNDERS COMPANY 1991, p. 894-898.

10.6.2008 .. . .. 17 : -: -: -: . : . : : . -, . : . , . , . - : , -

, 13, 3, . 122-141 2008

-

. ) , . N. meningitidis, S. pneumoniae H. influenzae b (Hib), 61%, 16% 7% . S. agalactiae E. coli , L. monocytogenes , , . ) , , . ( ), : 1) , 2) , 3) , 4) . , , , . ( : , , , , , , ).

... . . & . , .

1. . H. influenzae b 1990, -

B, 13, 3, 2008 94%, 55%. , 87% 1995, . , 15 1986, 25 1995, 39 2. , S. pneumoniae. ( . . ). : , . N. meningitidis: 1969-1971: ( C A C) . [Mengiva A+C (Sanofi-Pasteur), AC Vax (GlaxoSmithKline)]. 1978: (A/C/W-135/Y, MPSV4, Menomune Sanofi-Pasteur). . 1999: C ( 1-17 ). 2005: (MCV4

123

Menactra Sanofi-Pasteur) 11-55 2,3,4. S. pneumoniae: 1983: 23 ( 1, 2, 3, 4, 5, 6, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F, 33F). 2000: (PVC7) ( 4, 6, 9V, 14, 18C, 19F, 23F). PVC7 2000 2 , . , , , 6 19. 5,6. H. influenzae type b 1986: PRP (polyribosyl ribitol phosphate) 2 . 1991: 2 2. , . . , - , .

124

. , , , , , , , . , ( 1). 1, Gram S. pneumoniae, L. monocytogenes S. agalactiae. Gram N. meningitidis, H. influenzae E. coli K1. 1. . GRAM(+) S. pneumoniae L. monocytogenes S. agalactiae S. aureus S.epidermidis Enterococcus spp E. faecalis E. faecium E.casseliflavus E. gallinarum E. durans E. avium S. pyogenes S. bovis Viridans Streptococci S. suis B. anthracis P. acnes Nocardia spp GRAM() N. meningitidis H. influenzae E. coli K1 P. multocida F. necrophorum B. fragilis Capnocytophaga canimorsus F. meningosepticum Klebsiella species E. coli A. baumannii M. morganii S. marcescens C. freundii E. cloacae E. aerogenes P. mirabilis P. aeruginosa S. maltophilia Salmonella spp.

, , . , herd immunity ( ). S. agalactiae 1990: S. agalactiae ( B) . 2002: CDC, 2 S. agalactiae. S. agalactiae 2 1000 1990 0,3 1000 2004. , , , . 34%, 50% ( ). 2/3 . 1/3 ( )7. , , , , / , ..8

B, 13, 3, 2008 , . . 2/3 Gram S. agalactiae. S. agalactiae , ( III). E. coli, 80% E. coli 1 E. coli. L. monocytogenes (2-4%) Staphylococcus spp (5%), S. pneumoniae (0-5%). H. influenzae (0-3%) N. meningitidis (0-1%) . E. coli Gram , Klebsiella Enterobacter. Salmonella Mycobacterium tuberculosis , L. monocytogenes S. agalactiae 9. 1-23 S. pneumoniae, N. meningitidis

125

H. influenzae ( ). 2-18 N. meningitidis S. pneumoniae, 18 , S. pneumoniae N. meningitidis. , S. pneumoniae L. monocytogenes ( 2). N. meningitidis 16% 2. , . ( ).

2. . : 1-23 S. pneumoniae N. meningitidis H. influenzae S. agalactiae E. coli L. monocytogenes >18 S. pneumoniae (30-50%) N. meningitidis (10-35%) Staphylococcus spp (5-15%) Gram () (1-10%) Streptococcus spp (5%) L. monocytogenes (5%) H. influenzae (1-3%) >60 S. pneumoniae L. monocytogenes Gram () N. meningitidis

: 2-18 M. meningitidis (25-40%) S. pneumoniae (10-20%) Streptococcus spp (2-4%) Gram () (1-2%) H. influenzae Staphylococcus spp (1-2%) L. monocytogenes (1-2%)

126

S. pneumoniae (61% ). 65 . - , , . ( , ), , (, ), (HIV , , , ..). : 5-10%, . , 65%, 36%, () 25%. 18-29%,

11. 50% 82% Neisseriae spp ( 3). HIV 10 100 . HIV 12. 8-25%, . (33%), (25%) 24 (30-40%), . () . N. meningitidis ( ). H 11 . 3-13%.

3. . C1,C2 C4 . 20% , 2 , S. pneumoniae. C3: 70% , 2 , 55% Neisseria sp 39% S. pneumoniae, . : 50-60% , , N. meningitidis, (3.5%). C5-C9. 50-60% , 17 , N. meningitidis, (50%).

B, 13, 3, 2008 , 6%. 19-26%, (25-56%)2,5. H. influenzae Streptococcus agalactiae O H. influenzae 4548% 1986, 1995 7%. 90% H. influenzae 6 H. influenzae b (Hib) ( f). , Hib . , Hib 3 400.000-700.000 . Hib , / (shunt). H. influenzae 6 : , , (, HIV) H. influenzae 50% , 50% b 1,10,13.

127

: 50%. b 0,7% , 3-5% . 3-6%.

O Streptococcus agalactiae 14% . 20-30% . 50-70% . , , , . . . 7-27%. 2550% /. : , , 1,2,14,15. 15: 43% 83% . Listeria monocytogenes 2% 1,2. 50% 20% . ( 33%). ,

128

1. , 50% Gram (-) ( ..)20. S. aureus S. aureus , S. aureus, , S. aureus (MRSA) . , , ( ..). 50100% . : , , , , 1, . , 21. , 2006 MRSA PVL (Panton.Valentine leukocidin) 22, 2003 Pofelski J . S. aureus GISA ( ) 46 23. : Bacteroides spp., Bacteroides fragilis, Fusobacterium spp., Clostridium spp. Peptostreptococcus spp, Veillonella spp, Actinomyces spp, Propionibacterium acnes,

, , , , , . AIDS, , . TNF in vivo. TNF AIDS . . , 300 AIDS . 50 HIV . ( - ) . 5-10% ( ). , , . , . , , 70% / 16-19. Gram , , ,

B, 13, 3, 2008 Eubacterium spp. , , , , , , , . , , , , , .. 1,24. Nocardia: 75% Nocardia , , , .. 43% , (57%)25. - Enterococcus spp: (0,3-4%). , , shunts, Strongyloides stercoralis, . E. faecalis (76-90%), E. faecium (922%). (1333%). 12 E. faecium 26. 2005 E. casseliflavus27 2006

129

E. gallinarum28, 2007 E. avium29. S. bovis: S. bovis , . 2002 Vilarrasa ., Streptococcus bovis 45 42. S. pyogenes: S. pyogenes 0,2% . . , , . . , . S. pyogenes, . (Viridans streptococci) 1. S. salivarius: S. salivarius . , , .. 2. S. suis: S. suis . S. suis -

130

. , , . 4 . 5 (shunts). H. influenzae shunt, P. acnes shunts, . . , . CDC . 4. . ( Nelson M. Gantz20). (CNS) Gram () Streptococcus spp. S. aureus % 32 29 18 10 4 7

. ( 200/ l > 400/l > 105 /l >100 mg/dl , , , rifampicin >150 mg/dl ( )

B, 13, 3, 2008 0,1 l. , / l 1 x 10. , , . 30%, /l. , : = x = - . 1 700 7. , . 2. . ,

145

+ , . (May Grnvald- Giemsa), . /l , 1200 5-10. , . , . , Steele .9 32 % 2 50%. 3. , . . ,

2. 8. ( D-Dimer-Fibrin) 1

146

3. . > 1000/l < 500 10-1000 > 50 %

10 % 10. . 7 : , , , (> 4,2 mmol/l < 3 mmol/l > 35 mg/dl) . 50-60% , , . . : 34-119 mg /dl 40-80 mg /dl. . . . -

o . , . 50% / < 0,4 80% 96%6. . 15170 mg /dl 15-50 mg /dl. , . 80% 20% , (, ). / = 2:1 1:1 . 11: . , , . , , . , . , 1 mg/dl 1000

B, 13, 3, 2008 /l 7. > 150 mg /dl, . . 10% , 20% 10. , 7. 4 . : (), . , . -

147

Gram : Ziehl - Nielsen inoun , ( ) (auramine-rhodamine acridine orange) . , (Giemsa ). Gram . 60-90% , , (4060%)7. Gram ( 103 25% 105, 97%) . 5 Gram 7. Gram : 1200 5-10. 100 . .. 1 ml 100 ml12. -

4. .